| NPI | 1215416326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP60892908) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: WA AP60892908) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2023-02-23 |