| NPI | 1891214763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95011657) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 7960-033) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 7960) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WI 7960) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2023-08-29 |