| NPI | 1801902465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30005462) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 099007038N1) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |