| NPI | 1093287609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM RN-80640) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 718779) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2018-12-20 |