| NPI | 1346960564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP61681537) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61244910) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2025-10-06 |