| NPI | 1043884547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61182361) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA ARNP.AP.61182361-NP) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2023-07-28 |