| NPI | 1760852925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60919316) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN 00135235) |
| 163W00000X Registered Nurse (Licence: OR 099000146RN) | |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2019-10-31 |