NPI | 1851858641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61451476) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60797352) |
Enumeration Date | 2019-02-27 |
Last Update Date | 2024-08-22 |