| NPI | 1558495424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201708669NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-02428) |
| 363L00000X Nurse Practitioner (Licence: WA AP60084651) | |
| 364SC0200X Clinical Nurse Specialist, Critical Care Medicine (Licence: WA AP60084651) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-10-28 |