| NPI | 1376830299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60228997) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60097906) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2015-10-08 |