| NPI | 1376984682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60643437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131265) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2024-02-12 |