| NPI | 1407086671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60100851) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA IP60105319) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-07-22 |