| NPI | 1598372690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95016251) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: CA PENDING) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2022-03-15 |