| NPI | 1164206629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61570049) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60755713) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61570049) | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2025-06-27 |