| NPI | 1609358290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61062037) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 112595) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2021-12-01 |