| NPI | 1760831390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60657874) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60173936) |
| Enumeration Date | 2016-06-04 |
| Last Update Date | 2019-01-04 |