| NPI | 1497294995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61222240) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61218111) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA F06201694) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2023-03-01 |