NPI | 1003598285 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61562722) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61562722) |
Enumeration Date | 2023-08-07 |
Last Update Date | 2024-07-16 |