| NPI | 1225619620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61301707) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN61035237) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2023-06-10 |