| NPI | 1790048767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/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 |