NPI | 1205105038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 20354) |
Additional Taxonomies | 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 20354) |
Enumeration Date | 2011-12-22 |
Last Update Date | 2013-10-29 |