| NPI | 1427454354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60856340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MP NP14004) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2018-11-19 |