| NPI | 1487044962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR 221970) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61495401) |
| 363L00000X Nurse Practitioner (Licence: MO 2015001252) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2024-07-25 |