| NPI | 1336662576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95010754) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 722345) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-12-22 |