| NPI | 1841436417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60128753) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: WA 60128753) |
| 163W00000X Registered Nurse (Licence: WA RN 60023039) | |
| 207N00000X Dermatology (Licence: WA 60128753) | |
| Enumeration Date | 2008-12-31 |
| Last Update Date | 2024-02-20 |