| NPI | 1003598285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP61562722) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61562722) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2024-07-16 |