| NPI | 1447917943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61253026) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1018314) |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2025-07-07 |