| NPI | 1104633031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70029022) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: WA RN60455700) |
| Enumeration Date | 2024-12-13 |
| Last Update Date | 2025-08-13 |