| NPI | 1164206629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61570049) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WA 60755713) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2024-10-10 |