| NPI | 1841253408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200750136NP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP30005998) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2010-09-29 |