| NPI | 1437612512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61335662) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61335662) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2022-11-08 |