| NPI | 1932127115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30001488) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00082027) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-10-11 |