| NPI | 1427347384 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 7071364) | 
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60459728) | 
| Enumeration Date | 2011-03-31 | 
| Last Update Date | 2025-05-21 |