| NPI | 1104134386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60995298) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA 60133669) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95012894) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2020-12-17 |