| NPI | 1740793256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60733955) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60622161) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60733955) | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2018-07-02 |