| NPI | 1063188670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95033986) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 832724) |
| 363L00000X Nurse Practitioner (Licence: CA 95033986) | |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2025-03-03 |