| NPI | 1700359445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60949011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00136464) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60949011) | |
| Enumeration Date | 2019-01-05 |
| Last Update Date | 2019-07-19 |