| NPI | 1548426380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA NP10299) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA NP10299) |
| 364S00000X Clinical Nurse Specialist (Licence: CA CNS269) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2024-04-11 |