| NPI | 1942610969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95001405) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: CA 756111) |
| 163WC1500X Registered Nurse Community Health (Licence: CA 76149) | |
| 363L00000X Nurse Practitioner (Licence: CA 95100405) | |
| 163WH0500X Registered Nurse Hemodialysis (Licence: CA 756111) | |
| 363LF0000X Nurse Practitioner Family (Licence: WA AP61115863) | |
| 363LF0000X Nurse Practitioner Family (Licence: OR 202100564NP-PP) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2024-07-30 |