| NPI | 1689356388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN330008) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61473760) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2024-08-30 |