NPI | 1134430770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60163692) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201350097NP) |
Enumeration Date | 2010-06-29 |
Last Update Date | 2019-09-17 |