| NPI | 1265513675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 000033039N1 FNP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30007095) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-11-26 |