| NPI | 1750837548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60687161) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60093231) |
| 363L00000X Nurse Practitioner (Licence: WA AP60687161) | |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-05-30 |