| NPI | 1679179709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61691236) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: WA RN61092920) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2025-09-24 |