| NPI | 1235438433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI aprn-3257) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 1157) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA 60133272) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2023-12-18 |