| NPI | 1538793799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WA 61169259) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: WA RN60844763) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2021-05-24 |