| NPI | 1124532981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201710169np-pp) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60799726) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2018-03-07 |