| NPI | 1558601211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61044179) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 653079) |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2020-07-20 |