| NPI | 1538781851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61054843) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60361875) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61054843) | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2021-03-02 |