| NPI | 1245579408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OR 201604376NP-PP) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 22446) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: OR 201604376NP-PP) | |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 22446) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2023-03-20 |