| NPI | 1760604920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11014466) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 725533) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95004268) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95004268) | |
| 364SG0600X Clinical Nurse Specialist, Gerontology (Licence: CA 95004268) | |
| 364SP2800X Clinical Nurse Specialist, Perioperative (Licence: CA 587728) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2022-07-29 |