| NPI | 1295302297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: WA AP61158863) |
| Additional Taxonomies | 163WP0200X Registered Nurse Pediatrics (Licence: WA RN60351903) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2021-07-09 |