| NPI | 1013495274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60866914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60147630) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2020-12-21 |