| NPI | 1548742190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61027928) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 202001365NP-PP) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 21984) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61027928) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2023-09-06 |