| NPI | 1609330992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP60929537) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60929537) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60929537) | |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-05-02 |