| NPI | 1912205204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003557) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95003557) |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2025-10-29 |