| NPI | 1356068878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95022468) |
| Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: CA 95022468) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CA 95022468) | |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2022-10-25 |