| NPI | 1700647542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95022187) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95069170) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95069170) | |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2024-01-18 |