| NPI | 1558817395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60683732) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP10013) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2020-10-07 |