| NPI | 1043925563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61330248) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA RN60467658) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2026-06-05 |