| NPI | 1952687030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 20631) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 20631) |
| 363L00000X Nurse Practitioner (Licence: CA 20631) | |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2020-11-20 |