| NPI | 1760260855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10044323) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: HI 105985) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ID 70686) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OR 201906971RN) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95352640) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61679484) | |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2025-09-02 |