| NPI | 1801315585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61171292) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1939222) |
| 163W00000X Registered Nurse (Licence: WA AP61171294) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 5407) | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2023-12-01 |