| NPI | 1538480918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30004136) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 093006069N3) |
| Enumeration Date | 2010-06-19 |
| Last Update Date | 2010-06-19 |