| NPI | 1457649998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK NURU1255) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60207225) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60207225) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201500491NP-PP) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2024-12-16 |