| NPI | 1023742475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA ARNP.AP.70123596-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN.RN.60564669) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2026-08-14 |