| NPI | 1669217915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61582086) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 10035560) |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2025-08-12 |