| NPI | 1801235320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 14574) |
| Additional Taxonomies | 364SE0003X Clinical Nurse Specialist, Emergency (Licence: CA 2723) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2013-06-18 |