| NPI | 1710966163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP06347818) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ RN-075019) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2013-10-03 |