| NPI | 1225149073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP300061DS) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN00133747) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-11-12 |