| NPI | 1962695528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60673254) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034802) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2021-10-27 |