| NPI | 1245995323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 10046760) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95164584) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95017494) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-11-12 |