| NPI | 1710660253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA AP61567651) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61567651) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-06-27 |