| NPI | 1497472591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61440563) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 817329) |
| 163W00000X Registered Nurse (Licence: OR 202111331RN) | |
| 163W00000X Registered Nurse (Licence: WA RN60979252) | |
| 363L00000X Nurse Practitioner (Licence: NV 817329) | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2024-05-06 |