| NPI | 1417246067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP3007044) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP30007044) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP3007044) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP3007044) | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2025-01-28 |