| NPI | 1013266204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN RN0000158766) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 797995) |
| Enumeration Date | 2012-09-03 |
| Last Update Date | 2012-09-03 |