| NPI | 1063806479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60607117) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9363962) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60607117) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2021-09-09 |