| NPI | 1306099825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 13117) |
| Additional Taxonomies | 163WX0106X Registered Nurse, Occupational Health (Licence: CA 551822) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |