| NPI | 1467851709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-03409) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60841661) |
| 363L00000X Nurse Practitioner (Licence: WA RN60837088) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9336131) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5011815) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2021-04-14 |