| NPI | 1992296214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61401342) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9379248) |
| 363L00000X Nurse Practitioner (Licence: OR 10013567) | |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2023-08-29 |