| NPI | 1760042238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60978487) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.019519) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-09-08 |