| NPI | 1285653550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30004597) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP30004597) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-02-17 |