| NPI | 1902140007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 22258) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 824970) |
| 251E00000X Home Health (Licence: CA 22258) | |
| 363L00000X Nurse Practitioner (Licence: CA 22258) | |
| 363LC1500X Nurse Practitioner, Community Health (Licence: CA 22258) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 22258) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2018-09-11 |