| NPI | 1033709712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61389354) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61387620) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 3-000712) | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-02-03 |