| NPI | 1851858641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61451476) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60797352) |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2023-12-22 |