| 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 |