| NPI | 1053083329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61212689) |
| Additional Taxonomies | 364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: ID 5271158) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2025-04-01 |