| NPI | 1992131064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001491) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60728330) |
| 163W00000X Registered Nurse (Licence: WA RN00157038) | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-02-02 |