| NPI | 1659049583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95018297) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95018297) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2026-01-26 |