| NPI | 1649485517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9355672) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95065916) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9355672) | |
| 225X00000X Occupational Therapist (Licence: CA 10877) | |
| 225X00000X Occupational Therapist (Licence: FL OT7395) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95008115) | |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2020-10-05 |