| NPI | 1679201404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95022172) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10003801) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2026-06-21 |