| NPI | 1164893756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9351467) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9351467) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61215774) | |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2022-02-14 |