| NPI | 1942702915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61313787) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61313787) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61313787) | |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2024-09-30 |