| NPI | 1538793799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61168259) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61168259) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN60844763) | |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2025-11-14 |