| NPI | 1659751279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP 60598228) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00141942) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2020-11-12 |