| NPI | 1306219266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003369) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95003369) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95003369) | |
| Enumeration Date | 2015-11-01 |
| Last Update Date | 2021-11-30 |