| NPI | 1265216832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95026172) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95026172) |
| 163WC0400X Registered Nurse, Case Management (Licence: CA 95026172) | |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |