| NPI | 1346021755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95027439) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health (Licence: CA 95027439) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: CA 95027439) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CA 95027439) | |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: CA 95027439) | |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2023-10-11 |