| NPI | 1508544362 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA NP95033221) | 
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN264547) | 
| Enumeration Date | 2023-07-10 | 
| Last Update Date | 2025-05-12 |