| NPI | 1518402742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60717371) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60717277) |
| Enumeration Date | 2016-12-26 |
| Last Update Date | 2016-12-26 |