| NPI | 1659090744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95022333) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022333) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |