| NPI | 1205461522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61054509) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60575277) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-11-12 |