| NPI | 1619998291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30005453) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30005453) |
| 363L00000X Nurse Practitioner (Licence: WA AP30005453) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2011-12-09 |