| NPI | 1861026742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA 61077450) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60749075) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2020-06-18 |