| NPI | 1225789456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61513405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60293713) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2023-12-15 |