| NPI | 1831824366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61366229) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60927034) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2023-01-24 |