| NPI | 1568459816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP585A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30006354) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2012-09-10 |