| NPI | 1164445607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30006554) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 56617) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2018-03-17 |