| NPI | 1912368234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60610441) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 177890) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2024-07-17 |