NPI | 1457693558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60656076) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024170293) |
363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60656076) | |
Enumeration Date | 2013-03-27 |
Last Update Date | 2019-01-22 |