| NPI | 1245662048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60978479) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013013676) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2019-09-26 |