| NPI | 1013642909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95021878) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95021878) |
| Enumeration Date | 2022-07-24 |
| Last Update Date | 2022-10-31 |