| NPI | 1164786083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60460572) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200741480RN) |
| 163W00000X Registered Nurse (Licence: WA RN60186140) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-12-29 |