| NPI | 1427198852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60233048) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AK 345) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-12-02 |