| NPI | 1366856304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95000854) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 716471) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 2013001613) | |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 716471) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95000854) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 2015009739) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95000845) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95000845) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2024-01-18 |