| NPI | 1851391668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP3004210) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00086816) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2014-04-17 |