| NPI | 1770132896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61085291) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61085291) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5012227) | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2022-06-16 |