| NPI | 1427681972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP61167487) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60297589) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2021-06-16 |