| NPI | 1538940069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61515469) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-4279) |
| Enumeration Date | 2023-10-10 |
| Last Update Date | 2024-03-27 |