| NPI | 1780325829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WA AP61271380) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner Gerontology (Licence: WA AP61271380) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-03-03 |