| NPI | 1366021818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61351555) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60099129) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2022-12-05 |