NPI | 1275277527 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10041706) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70007887) |
Enumeration Date | 2022-04-22 |
Last Update Date | 2025-09-25 |