| NPI | 1932982196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95026629) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: CA 95026629) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95026629) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 95026629) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95026629) | |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-08-14 |