| NPI | 1457816035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60942015) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: WA RN60262699) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2024-12-03 |