| NPI | 1467166546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA NP95031072) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60291550) |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2026-04-18 |