| NPI | 1750333431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP30004258) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP 9181364) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2009-12-14 |