| NPI | 1114608387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61570149) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60853545) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2024-12-05 |