| NPI | 1295250124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60775676) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA ap60775676) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2020-07-20 |