| NPI | 1720542301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11016844) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60930114) |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2021-12-22 |