| NPI | 1073994927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CA 95002412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 95002412) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95002412) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95002412) | |
| 363LC1500X Nurse Practitioner Community Health (Licence: CA 95002412) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95002412) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: CA 95002412) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95002412) | |
| 363LS0200X Nurse Practitioner School (Licence: CA 95002412) | |
| 363LW0102X Nurse Practitioner Women's Health (Licence: CA 95002412) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2025-02-07 |