| NPI | 1831658145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95019150) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R166452) |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2022-05-17 |