| NPI | 1174513477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60607171) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 123413-4405) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2025-11-26 |