| NPI | 1902689425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP61588691) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60172888) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61588691) | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2025-05-07 |