| NPI | 1922449065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61531156) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 386099) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2024-03-21 |