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 |