| NPI | 1013434695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60983706) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 345142) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-089091) | |
| Enumeration Date | 2017-08-24 |
| Last Update Date | 2022-10-17 |