| NPI | 1073091427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60896900) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WA RN60225557) |
| Enumeration Date | 2018-07-29 |
| Last Update Date | 2021-08-17 |