| NPI | 1073175014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: HI APRN-3074) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60974084) |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2021-06-09 |