| NPI | 1962244152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60930125) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: WA AP60954237) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-06-10 |