| NPI | 1184305716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61562395) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA RN60975551) |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2024-07-16 |