| NPI | 1366449316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 45863) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30006651) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2007-07-08 |