| NPI | 1033932413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61651720) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60798186) |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2025-02-12 |