| NPI | 1164710554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R170593) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95218901) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: CA 95014347) | |
| 363L00000X Nurse Practitioner (Licence: CA 95014347) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2023-06-01 |