NPI | 1598292120 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA AP60750107) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60750107) |
363LF0000X Nurse Practitioner, Family (Licence: WA AP60750107) | |
363L00000X Nurse Practitioner (Licence: WA AP60750107) | |
Enumeration Date | 2017-05-13 |
Last Update Date | 2024-03-04 |