| NPI | 1235189622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1014A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA AP30006327) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2016-06-23 |