| NPI | 1487375341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61550660) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR 219108) |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2024-07-02 |