| NPI | 1700189479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61260884) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61260852) |
| 363L00000X Nurse Practitioner (Licence: NM CNP01712) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-01712) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61260884) | |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2022-12-14 |