| NPI | 1780427658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP70012016) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 11109444-3102) |
| 163W00000X Registered Nurse (Licence: WA RN61134967) | |
| 163W00000X Registered Nurse (Licence: CA 95276432) | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2025-07-21 |