| NPI | 1639416142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 21980) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60806834) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60806834) | |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2023-03-01 |