| NPI | 1861631384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60053849) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60053849) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2019-03-31 |