| NPI | 1740114396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95039953) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: CA 95039953) |
| Enumeration Date | 2026-06-10 |
| Last Update Date | 2026-08-21 |