NPI | 1770015158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60781220) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60669035) |
Enumeration Date | 2017-04-03 |
Last Update Date | 2017-09-25 |