| NPI | 1699931493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA 60101140) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 2962202) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 737610) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 200843205RN) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2009-10-21 |