| 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 |