| NPI | 1598167678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60763634) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60220015) |
| Enumeration Date | 2014-09-21 |
| Last Update Date | 2023-07-25 |