| NPI | 1174178933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95015990) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95043215) |
| 163WE0003X Registered Nurse, Emergency (Licence: CA 95043215) | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2020-11-19 |