| NPI | 1710612858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61336321) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP.61336321) |
| 163W00000X Registered Nurse (Licence: WA RN61155865) | |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2022-12-01 |