| NPI | 1649068735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70061999) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11039103) |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-11-26 |