| NPI | 1912481300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95009656) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95009656) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95009656) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2018-09-20 |