| NPI | 1356866255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60806831) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9351816) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: WA AP60806831) | |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2020-06-07 |