| NPI | 1114175973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60044793) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN00168049) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2016-05-02 |