| NPI | 1972026391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95006730) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95006730) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2018-01-18 |