| NPI | 1639615636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95022446) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308155) |
| 163W00000X Registered Nurse (Licence: NY 634664) | |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2024-05-13 |