| NPI | 1417037375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30002294) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00086779) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-08-26 |