| NPI | 1699819292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 59480) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60910202) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2018-12-05 |