| NPI | 1417395724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60386653) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60128646) |
| 363L00000X Nurse Practitioner (Licence: WA AP60386653) | |
| Enumeration Date | 2013-06-08 |
| Last Update Date | 2022-06-27 |