| NPI | 1760425466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30007182) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA RN00145694) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2020-11-12 |