| NPI | 1023673209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 61628) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60981194) |
| 363L00000X Nurse Practitioner (Licence: WA AP60981196) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2021-05-26 |