| NPI | 1346756137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60900674) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60766575) |
| Enumeration Date | 2017-12-16 |
| Last Update Date | 2025-03-10 |