| NPI | 1104332469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 799229) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: CA 799229) |
| Enumeration Date | 2017-12-22 |
| Last Update Date | 2017-12-22 |