| NPI | 1710660253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CO APN.0106081-NP) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA AP61567651) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61567651) | |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2026-03-22 |