| NPI | 1821608647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61085401) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61063322) |
| 163W00000X Registered Nurse (Licence: DE L1-0074753) | |
| 363L00000X Nurse Practitioner (Licence: DE LG-0013060) | |
| 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0013060) | |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2024-12-12 |