NPI | 1811654205 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61457369) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 940276) |
163W00000X Registered Nurse (Licence: WA RN61457362) | |
363L00000X Nurse Practitioner (Licence: TX 1070207) | |
Enumeration Date | 2021-11-20 |
Last Update Date | 2025-03-28 |