| NPI | 1326412438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61095914) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA RN60523099) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2026-06-07 |