| NPI | 1821715285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 10004408) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61369075) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2025-09-07 |