| NPI | 1962883249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: GA RN214460) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60933179) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: WA AP60933179) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2022-05-13 |