NPI | 1194250670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95007809) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 695922) |
163WC1500X Registered Nurse, Community Health (Licence: CA 71519) | |
363L00000X Nurse Practitioner (Licence: CA 95007809) | |
363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95007809) | |
363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95007809) | |
Enumeration Date | 2017-04-21 |
Last Update Date | 2021-12-28 |