| NPI | 1093351447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61008322) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60092579) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2023-08-07 |