| NPI | 1073747754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner Occupational Health (Licence: MA 199897) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI 37117) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2020-04-27 |