| NPI | 1285236687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 9329) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61109491) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA N361122516) | |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2022-11-01 |