| NPI | 1275377715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61599244) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61206990) |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2024-09-22 |