| NPI | 1275961492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60423423) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60289342) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2019-10-29 |