| NPI | 1023338233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60281164) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050082NP) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2022-11-28 |