| NPI | 1316169717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 090006597N1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30001769) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |