| NPI | 1063741205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95000338) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R188868) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2022-02-14 |