| NPI | 1174164875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AK 171643) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61012001) |
| 363L00000X Nurse Practitioner (Licence: WA RN60539229) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA RN60539229) | |
| 363L00000X Nurse Practitioner (Licence: WA AP61012001) | |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2021-07-01 |