| NPI | 1710415559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0200X Registered Nurse, Pediatrics (Licence: CA 95321194) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95026854) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71007277A) | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2024-06-20 |