| NPI | 1336722354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61583942) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2024-08-19 |