| NPI | 1275582751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP733A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID N34935) |
| 363L00000X Nurse Practitioner (Licence: WA RN00161870) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30007150) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-04-18 |