| NPI | 1669282307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61645482) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61645482) |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2026-07-16 |