| NPI | 1588905699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60641080) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ID NP-1272A) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2021-06-09 |