| NPI | 1508299348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: ID NP-1308A) |
| Additional Taxonomies | 363LX0106X Nurse Practitioner Occupational Health (Licence: ID NP-1308A) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2013-08-15 |