| NPI | 1326763996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61362742) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61362742) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2024-12-26 |