| NPI | 1174166599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA 61589022) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60116378) |
| Enumeration Date | 2019-10-18 |
| Last Update Date | 2024-10-25 |