| NPI | 1962064683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60967038) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: WA RN60322652) |
| 363LF0000X Nurse Practitioner Family (Licence: WA AP60967038) | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-10-28 |