| NPI | 1871092254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95008560) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CA 95008560) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2022-04-22 |