| NPI | 1770023277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61321571) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9359184) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2024-01-11 |