| NPI | 1396315446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61341945) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WA rn60622225) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-09-09 |