| NPI | 1881586766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: CA 95036662) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: CA 95253507) |
| Enumeration Date | 2025-07-16 |
| Last Update Date | 2025-09-05 |