| NPI | 1396263604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: CA 123EXAMPLE) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: CA 123EXAMPLE) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: CA 123EXAMPLE) | |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: CA 123EXAMPLE) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA 123EXAMPLE) | |
| 363LG0600X Nurse Practitioner Gerontology (Licence: CA 123EXAMPLE) | |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: CA 123EXAMPLE) | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2019-03-14 |