| NPI | 1467764647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60147803) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050075NP) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2019-10-29 |