| NPI | 1245832765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95009666) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95009666) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95009666) | |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2024-03-07 |