| NPI | 1336790070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61417695) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61417695) |
| 163W00000X Registered Nurse (Licence: WA RN00166711) | |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2025-12-19 |