| NPI | 1396218129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60923092) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60094648) |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2019-04-03 |