| NPI | 1407887615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP30003649) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00112401) |
| 363L00000X Nurse Practitioner (Licence: WA AP30003649) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-01-19 |