| NPI | 1487368296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP70012064) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201705910RN) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10031480) | |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2025-08-11 |