| NPI | 1700541208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61214097) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WA AP61214097) |
| 363L00000X Nurse Practitioner (Licence: WA AP61214097) | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2022-06-08 |