| NPI | 1477216653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61363452) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60867566) |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2026-01-06 |