| NPI | 1104026178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID 55135) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP 17044) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA NP 17044) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2022-07-21 |