| NPI | 1437667789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA 61443413) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-78276-022) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2018001749) | |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2023-08-02 |