| NPI | 1477124253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70023739) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046658) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 328363) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2025-10-07 |