| NPI | 1477970713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 16570I) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP-9340098) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA 60650287) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2023-08-02 |