| NPI | 1043947989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61327779) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61327779) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2024-10-08 |