| NPI | 1578189262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61085325) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95014763) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95014763) | |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2023-08-21 |