| NPI | 1790168870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95003072) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: CA 767564) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-06-24 |