| 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 |