| NPI | 1427328731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60583458) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP60583458) |
| 363LF0000X Nurse Practitioner Family (Licence: NM CNP-02157) | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2021-11-09 |