| NPI | 1174174247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61002864) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00167115) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2024-05-03 |