| NPI | 1487044723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60699819) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 784688) |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95001918) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2021-12-22 |