| NPI | 1316453608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60787311) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60668355) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2026-06-06 |