| NPI | 1134586720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA NP95003596) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60822207) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2026-02-12 |