| NPI | 1427649508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WA AP61095362) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1012262) |
| 363L00000X Nurse Practitioner (Licence: WY AP61095362) | |
| 363L00000X Nurse Practitioner (Licence: WA AP61095362) | |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2022-07-05 |