| NPI | 1043663446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60838859) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 7693456-4405) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7693456-8900) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2018-08-07 |