| NPI | 1639850142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61466830) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61466830) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2024-07-01 |