| NPI | 1619224508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60581583) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60581583) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60581583) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 21511) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2025-04-24 |