| NPI | 1457964447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: WA AP61430136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60239144) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-04-24 |