| NPI | 1144467028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 16884) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA 1407) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NPF16884) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 16884) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2025-12-30 |