NPI | 1043608458 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 54815) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA ap60547004) |
Enumeration Date | 2015-01-07 |
Last Update Date | 2025-07-25 |