| NPI | 1669340022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95037207) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95037207) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95037207) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95037207) | |
| Enumeration Date | 2025-10-28 |
| Last Update Date | 2026-06-08 |