| NPI | 1730103359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60292404) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60292404) |
| 363L00000X Nurse Practitioner (Licence: NE 110790) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-09-27 |