| NPI | 1427539766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60904914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00116099) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2022-08-01 |