| NPI | 1619178894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP0006796) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN0014160) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2022-11-04 |