| NPI | 1568905107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD R251567) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60863630) |
| 163W00000X Registered Nurse (Licence: GA rn216522) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA 2016024386) | |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2024-06-06 |