| NPI | 1871865972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95028600) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 990306) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2024-11-15 |