| NPI | 1730600768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60914138) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60914138) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10410) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2026-03-02 |