| NPI | 1558909705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95012670) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 792313) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95012670) | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2024-01-19 |