| NPI | 1053668335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60628896) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA 22398) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 22998) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2021-05-20 |