| NPI | 1972771186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30007045) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00079183) |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2011-12-01 |