| NPI | 1033586532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95022876) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60592750) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60592750) | |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2023-01-12 |