| NPI | 1093734618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30007078) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00108880) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2014-01-06 |