| NPI | 1689370405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95018746) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: CA 95018746) |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2023-09-12 |