| NPI | 1740671601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61321127) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP61321127) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP127466) | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2022-07-13 |