| NPI | 1679121966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61004470) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60094085) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2019-11-26 |