| NPI | 1740900794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP70012315) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60435712) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2025-07-01 |