| NPI | 1528436615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95005425) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NE 111898) |
| 163W00000X Registered Nurse (Licence: NE 71240) | |
| 163W00000X Registered Nurse (Licence: CA 783549) | |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2025-11-17 |