| NPI | 1467124107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61420994) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95024190) |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2025-02-21 |