| NPI | 1508069956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61292842) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200750059NP) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2022-10-13 |