| NPI | 1235540881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60506155) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60284481) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2015-01-02 |