| NPI | 1295373959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61201963) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RN60306204) |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2021-09-20 |