| NPI | 1952308520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60341113) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60341113) |
| 163W00000X Registered Nurse (Licence: WA RN60329776) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2016-07-13 |