| NPI | 1376021352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11002217) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP11002217) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61583901) | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-12-03 |