| NPI | 1710434493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60938185) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60456647) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP60938185) | |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2022-01-31 |