| NPI | 1942724547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61007496) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71007309A) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2021-09-18 |