| NPI | 1215489125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60897300) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ID 54389) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2018-11-12 |