| NPI | 1346564200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 1142) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP 60128758) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2019-10-11 |