| NPI | 1295227502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95001367) |
| Additional Taxonomies | 364SC0200X Clinical Nurse Specialist, Critical Care Medicine (Licence: CA 4209) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2018-06-01 |