| NPI | 1194952218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 20405) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 20405) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: CA 20405) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 20405) | |
| 363L00000X Nurse Practitioner (Licence: CA 20405) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 715183) | |
| 171000000X Military Health Care Provider (Licence: CA 715183) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 20405) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 20405) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2014-11-03 |