| NPI | 1790419802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61560376) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61072636) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2024-05-11 |