| NPI | 1700055795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60432813) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: WA RN00148862) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2014-03-19 |