NPI | 1790048767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 21343) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 21343) |
363LF0000X Nurse Practitioner, Family (Licence: CA 21343) | |
363LP2300X Nurse Practitioner, Primary Care (Licence: CA 21343) | |
364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: CA 3467) | |
Enumeration Date | 2012-06-24 |
Last Update Date | 2024-04-12 |