| NPI | 1598799546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30006276) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00133865) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP30006276) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-11-05 |