| NPI | 1407618739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: WA AP61598671) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60929310) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2024-08-23 |