| NPI | 1740596873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 19119) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID NP1526A) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: CA 19119) | |
| 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: CA 19119) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2015-10-01 |