| NPI | 1376089219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95006263) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: CA 95006263) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: CA 95006263) | |
| 363L00000X Nurse Practitioner (Licence: CA NPF95006263) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: CA 95006263) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2023-06-29 |