| NPI | 1497389811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WA AP61256697) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: OR 202200913NP-PP) |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2022-03-13 |