| NPI | 1760631469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30007729) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA AP30007729) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2018-12-17 |