| NPI | 1255721239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95001892) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: NY 43 430872) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2023-05-24 |