| NPI | 1376918383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: ID NP-1692A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60627369) |
| 363L00000X Nurse Practitioner (Licence: ID NP-1692A) | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2023-10-03 |