| NPI | 1528694106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60213730) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61311416) |
| Enumeration Date | 2020-03-16 |
| Last Update Date | 2024-04-11 |