| NPI | 1518649771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61491164) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WA RN60835963) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-10-12 |