| NPI | 1093274607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TX AP140975) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61320029) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2023-11-09 |