| NPI | 1699177873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0997570-NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60772360) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA 60773135) | |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2023-07-17 |