| NPI | 1538947957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA RN70073767) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 34391) |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2025-12-08 |