| 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 |