| NPI | 1164812798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WA AP60497652) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: WA AP60497652) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2022-02-25 |