| NPI | 1992330179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61297371) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60499925) |
| Enumeration Date | 2020-03-07 |
| Last Update Date | 2022-05-06 |