| NPI | 1528102100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30004952) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN00068129) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2009-07-30 |