| NPI | 1386274348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA ML61243548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60621923) |
| 207R00000X Internal Medicine (Licence: WA ML61243548) | |
| Enumeration Date | 2020-01-18 |
| Last Update Date | 2024-04-08 |