| NPI | 1992371082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61200870) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60865808) |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2022-11-04 |