| NPI | 1457983496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61176954) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: WA RN60583305) |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 95080407) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95018031) | |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2024-03-06 |