| NPI | 1205233400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA 60522734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA AP60522734) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2024-07-16 |