| NPI | 1437185071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30004883) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA AP30004883) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2014-02-20 |