| NPI | 1508943846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30007152) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00156443) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-11-30 |