| NPI | 1669926986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP60675089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60280980) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2018-09-27 |