| NPI | 1265009559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61418651) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024182074) |
| 363L00000X Nurse Practitioner (Licence: WA RN61276312) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2026-03-13 |