| NPI | 1467800425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60688447) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60688447) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RN60650163) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL RN9400070) | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2024-06-14 |