| NPI | 1336677731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61284940) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00167352) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-03-27 |