| NPI | 1285001628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: CA 95003066) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95003066) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95003066) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2020-12-03 |