| NPI | 1174561468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201150165NP) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA AP30006102) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30006102) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-03-07 |