| NPI | 1962495903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30001736) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00093420) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2012-02-24 |