| NPI | 1831439454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201350024NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201350024) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2020-04-27 |