| NPI | 1346760022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95009612) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 722006) |
| 163W00000X Registered Nurse (Licence: CA 95126034) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-07-09 |