| NPI | 1750119731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61597592) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA RN60315149) |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2024-10-01 |