| NPI | 1073994927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95002412) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95002412) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: CA 95002412) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95002412) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95002412) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95002412) | |
| 363LP0808X Nurse Practitioner, Psych/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 | 2018-05-10 |