| NPI | 1073000345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60898522) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00129188) |
| Enumeration Date | 2018-04-22 |
| Last Update Date | 2018-09-25 |