| NPI | 1891982286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200750074NP FNP-PP) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 200750074NP) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2024-09-07 |