| NPI | 1497855308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30000996) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10003561) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-04-29 |