| NPI | 1255629267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60241846) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP-1086A) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2023-07-18 |