| NPI | 1205877727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30007002) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN00158155) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-11-12 |