| NPI | 1003560459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61271241) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA RN60098073) |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2023-09-27 |