| NPI | 1164437588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60106718) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 097006656) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2011-08-30 |