| NPI | 1982486098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61650797) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 314678) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2025-04-02 |