| NPI | 1790287811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60882992) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WA RN60223202) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2023-10-24 |