| NPI | 1487052676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA DI60286970) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60479749) |
| Enumeration Date | 2014-12-20 |
| Last Update Date | 2017-02-13 |