| NPI | 1487823076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30007979) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00155580) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2018-07-02 |