| NPI | 1861154577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61396149) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: WA RN60371368) |
| Enumeration Date | 2021-10-10 |
| Last Update Date | 2023-02-15 |