| NPI | 1780241794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0994692-NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61177225) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61177225) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2024-06-19 |