| NPI | 1316331838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95004527) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95075181) |
| 163W00000X Registered Nurse (Licence: NY 6934381) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2022-06-10 |