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 |