| NPI | 1396167094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 23754) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5258) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA NP23754) | |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2022-09-08 |