| NPI | 1619865995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95035330) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: CA 5210) |
| 364SC0200X Clinical Nurse Specialist, Critical Care Medicine (Licence: CA 5210) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95035330) | |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: CA 5210) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: CA 5210) | |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2025-06-25 |