| NPI | 1902324445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA 60781223) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60755263) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA 60781223) | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2021-04-29 |