| NPI | 1619418365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60852261) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP133564) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2020-02-18 |