| NPI | 1518419738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60711448) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 843708) |
| 363LF0000X Nurse Practitioner Family (Licence: ID 78680) | |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2024-04-24 |