| NPI | 1053654913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60896880) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA rn60089738) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2026-04-14 |