| NPI | 1619547650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: WA AP61186242) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 27622) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2021-11-22 |