| NPI | 1568771517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA RN60032814) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OR 201050186NP) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2014-10-23 |