| NPI | 1497238984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95009801) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD AC002434) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2023-07-26 |