| NPI | 1821563073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95010238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95051033) |
| 163WP0000X Registered Nurse, Pain Management (Licence: CA 95010238) | |
| 261QP3300X Clinic/Center, Pain (Licence: CA 95010238) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95010238) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95010238) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 95010238) | |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2025-07-21 |