| 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 |