| NPI | 1487026423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP6106944) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 6488) |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2026-05-05 |