| NPI | 1124685045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60930259) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP141227) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 65670) | |
| Enumeration Date | 2019-05-27 |
| Last Update Date | 2023-06-02 |