| NPI | 1750567129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: OR 201909324NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP2889) |
| 363L00000X Nurse Practitioner (Licence: WA AP60681430) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2020-02-26 |