| NPI | 1528532306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10004744) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA 60919295) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2023-02-21 |