| NPI | 1902387293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95009361) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NV 841328) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NV 841328) | |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2024-09-04 |