| NPI | 1790476448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95023287) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61505473) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2024-05-03 |