| NPI | 1104547801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP70004069) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60469002) |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2025-06-02 |