| NPI | 1386177129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95006189) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95061349) |
| 163WC1500X Registered Nurse Community Health (Licence: CA 550753) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA 95006189) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CA 95006189) | |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2024-04-01 |