| NPI | 1376885590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60627373) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60627347) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2019-04-03 |