| NPI | 1689340515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61540212) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61540212) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 29874) | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-04-22 |