| NPI | 1174616676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN00143166) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: WA PH00017416) |
| 363LF0000X Nurse Practitioner Family (Licence: WA AP30006592) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |