| NPI | 1164194676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95018650) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95018650) |
| Enumeration Date | 2021-10-03 |
| Last Update Date | 2024-06-17 |