| NPI | 1811464993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA N360911342) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 59834) |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2018-10-26 |