| NPI | 1023490786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61483024) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60204513) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2025-11-20 |