| NPI | 1912341108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201406164NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN-60257006) |
| 163W00000X Registered Nurse (Licence: OR 200041207-RN) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2022-03-10 |