| NPI | 1992473706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202211907NP-PP) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OR 201602206RN) |
| 363L00000X Nurse Practitioner (Licence: WA AP61354264) | |
| Enumeration Date | 2021-09-06 |
| Last Update Date | 2022-10-12 |