| NPI | 1154955409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61056501) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60622248) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61056501) | |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2022-07-25 |