| NPI | 1477717130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA Pending) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201907594NP-PP) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2025-07-02 |