| NPI | 1831570191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60598011) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60092106) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2015-09-21 |