| NPI | 1720178585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: WA AP30007765) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 0009-30105) |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: WA AP30007765) | |
| 363L00000X Nurse Practitioner (Licence: WA AP30007765) | |
| 163W00000X Registered Nurse (Licence: WA RN00173151) | |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: WA 30007765) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-10-12 |