| NPI | 1942375043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201250091NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 10625) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: OR 201250091NP) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2025-03-13 |