| NPI | 1346747391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95008863) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: CA 95008863) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95008863) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2022-05-31 |