| NPI | 1215764857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95031963) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95263861) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-10-05 |