| NPI | 1073715793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60217026) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN R-178415-0) |
| 363L00000X Nurse Practitioner (Licence: WA AP60217026) | |
| 363L00000X Nurse Practitioner (Licence: MN R-178415-0) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2019-05-15 |