| NPI | 1598135782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60794614) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60783819) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2022-01-07 |