NPI | 1003460064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60957049) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60957049) |
Enumeration Date | 2019-07-29 |
Last Update Date | 2023-11-03 |