| NPI | 1184253494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95014278) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95014278) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP95014278) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA NP95014278) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2020-04-07 |