| NPI | 1568985646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: HI APRN-2694) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP60774418) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2023-11-27 |