| NPI | 1306489760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NP95012775) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA 60991336) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2022-08-24 |