| NPI | 1154651933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60126973) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP3495) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2017-03-11 |