| NPI | 1538946215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10006780) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61464070) |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-11-06 |