| NPI | 1831727361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61228865) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61201767) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-06-27 |