| NPI | 1366402661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC APN 1074) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC APN 1074) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: SC APN 1074) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2007-07-08 |