| NPI | 1417903576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: CO 71129) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 71129) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2011-04-04 |