| NPI | 1356519474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 17641) |
| Additional Taxonomies | 174400000X Specialist |
| 364SM0705X Clinical Nurse Specialist, Medical-Surgical (Licence: CA NP17641) | |
| Enumeration Date | 2008-02-11 |
| Last Update Date | 2025-01-06 |