| NPI | 1871944538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61066254) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1025305) |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 202210760NP-PP) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-10-10 |