| NPI | 1366845257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA RN60367859) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60514687) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2023-07-17 |