| NPI | 1215420518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60911409) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 163W00000X Registered Nurse (Licence: WA RN60766085) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2026-06-17 |