| NPI | 1144918871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP026048) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA N361435628) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-11-04 |