| NPI | 1679990089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60443170) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00166538) |
| 363L00000X Nurse Practitioner (Licence: WA AP60443170) | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2021-01-18 |