| NPI | 1699094623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP30004092) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050071NP) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2015-11-23 |