NPI | 1689823551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: WA RN00143594) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA RN00143594) |
Enumeration Date | 2008-09-16 |
Last Update Date | 2009-04-08 |