| NPI | 1932868296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OR 10006706) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10006706) |
| 163W00000X Registered Nurse (Licence: WA RN61212475) | |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2024-09-04 |