| NPI | 1336857606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95023231) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95023231) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95023231) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95023231) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95023231) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2024-01-10 |