| NPI | 1366514051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN00088730) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30003185) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |