| NPI | 1558496158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OR 081047114N3 ANP-PP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP30003743) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2008-01-14 |