| NPI | 1538305057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60070792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00152476) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2022-02-16 |