| NPI | 1487995528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61287895) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201350038NP) |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2022-06-01 |