| NPI | 1013729292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 80410) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61596679) |
| Enumeration Date | 2025-01-23 |
| Last Update Date | 2025-01-23 |