| NPI | 1922194653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61552283) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95032418) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9366274) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-10-01 |