| NPI | 1730311564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1305A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60100852) |
| 363L00000X Nurse Practitioner (Licence: ID NP-1305A) | |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2023-12-13 |