| NPI | 1548226376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61249297) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 8232) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN RN133351) | |
| 213E00000X Podiatrist (Licence: WA AP61249297) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2022-06-22 |