| NPI | 1548589377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60428479) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 166020) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TN 15888) | |
| 163W00000X Registered Nurse (Licence: WA RN60419211) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2014-04-21 |