| NPI | 1588401392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5020559) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61587364) |
| 163WE0003X Registered Nurse, Emergency (Licence: IA 122373) | |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2025-03-27 |