| NPI | 1346643608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60637595) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 23668) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2021-08-24 |