| NPI | 1750461794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: CA 16795) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 16795) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2013-08-19 |