| NPI | 1770696221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 000038096N3) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30005823) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-07-08 |