| NPI | 1073517793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: WA AP3005740) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30005740) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-01-14 |