NPI | 1710294970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60838887) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60838887) |
Enumeration Date | 2010-09-09 |
Last Update Date | 2023-09-18 |