| NPI | 1114253457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60118946) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60118146) |
| 163W00000X Registered Nurse (Licence: CA RN709195) | |
| 163WC1500X Registered Nurse, Community Health (Licence: CA PHN74857) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP19114) | |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2013-02-19 |