| NPI | 1194447334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61478226) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60651641) |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2024-05-20 |