| NPI | 1508868274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30004763) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30004763) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2021-02-18 |