| NPI | 1124353719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61081911) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 65287) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2024-06-27 |