| NPI | 1245655869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95010827) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MD AC001317) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2020-03-20 |