| NPI | 1780667360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 432043) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: CA NP11409) |
| 146N00000X Emergency Medical Technician, Basic (Licence: CA RN432043) | |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: CA 432043) | |
| 146N00000X Emergency Medical Technician, Basic (Licence: CA 432043) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2017-02-23 |