| NPI | 1457071433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61432543) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60261062) |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2023-05-08 |