| NPI | 1295414746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: WA AP61468286) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: WA 61448412) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2023-08-21 |