NPI | 1952545048 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61168278) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60624911) |
363LF0000X Nurse Practitioner, Family (Licence: CA 95036572) | |
363LF0000X Nurse Practitioner, Family (Licence: FL TPAN3527) | |
Enumeration Date | 2009-04-21 |
Last Update Date | 2025-08-10 |