| NPI | 1366061285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95015622) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95015622) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95015622) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2022-08-01 |