| NPI | 1154042695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP70001287) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60693866) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2025-07-24 |