| NPI | 1619335544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95003644) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95003644) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95003644) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95003644) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: CA 95003644) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95003644) | |
| Enumeration Date | 2016-02-06 |
| Last Update Date | 2016-02-06 |