| NPI | 1073532305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30003468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00068957) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-04-30 |