| NPI | 1700496379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP61330071) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner School (Licence: MD R236257) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2022-07-13 |