| NPI | 1457870586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95012974) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 238714) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 87827) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95028029) | |
| Enumeration Date | 2017-09-09 |
| Last Update Date | 2019-12-30 |