| NPI | 1043991730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61562816) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61562816) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: WA Rn60274884) | |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2024-09-05 |