| NPI | 1144748815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60911371) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WA RN60002190) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2022-07-21 |