| NPI | 1952778359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61017451) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS R888153) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2024-06-20 |