| NPI | 1326757212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61391825) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA F10220870) |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2023-02-06 |