| NPI | 1952024366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP70000483) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60859539) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2026-02-23 |