| NPI | 1366161812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95039666) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95199620) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2026-06-01 |