| NPI | 1669434403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30005735) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 62899) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2020-12-10 |