| NPI | 1467120840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN10021104) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95086714) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95018707) | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2025-04-30 |