| NPI | 1265832901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61593143) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60045823) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2024-08-13 |