NPI | 1548589377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP60428479) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 166020) |
363LA2200X Nurse Practitioner, Adult Health (Licence: TN 15888) | |
163W00000X Registered Nurse (Licence: WA RN60419211) | |
Enumeration Date | 2010-05-18 |
Last Update Date | 2014-04-21 |