| NPI | 1588627129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WA AP3005263) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WA AP3005263) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2007-07-08 |