NPI | 1326763996 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61362742) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61362742) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2022-10-06 |
Last Update Date | 2024-12-26 |