| NPI | 1184174492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60825078) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA F06162596) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2021-03-31 |