| NPI | 1821601675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61451230) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60339321) |
| 163W00000X Registered Nurse (Licence: UT 372333-3102) | |
| Enumeration Date | 2020-08-30 |
| Last Update Date | 2023-06-15 |