| NPI | 1093182859 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95012277)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95070046)  | 
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA 95012277)  | |
| 363L00000X Nurse Practitioner (Licence: CA 95012277)  | |
| 364S00000X Clinical Nurse Specialist (Licence: CA 4768)  | |
| Enumeration Date | 2015-08-27 | 
| Last Update Date | 2023-08-06 |