| NPI | 1376367912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61647966) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61647966) |
| 363L00000X Nurse Practitioner (Licence: WA AP61647966) | |
| 163W00000X Registered Nurse (Licence: WA RN61067569) | |
| Enumeration Date | 2024-11-11 |
| Last Update Date | 2026-06-15 |