| NPI | 1932948783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61556524) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61537619) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2024-07-30 |