| NPI | 1922001478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201050227NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP-674A) |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2024-06-13 |