| NPI | 1457059560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60244858) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61468473) |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: WA AP61468472) | |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-09-14 |