| NPI | 1811582687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61479225) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60454989) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2024-02-06 |