| NPI | 1053636720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA LIC#604372) |
| Additional Taxonomies | 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA LIC#604372) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2010-04-06 |