| NPI | 1104221167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CA NP95001434) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA NP95001434) |
| 363LA2200X Nurse Practitioner Adult Health (Licence: CA NP95001434) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: CA NP95001434) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002596) | |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2025-04-24 |