| NPI | 1114393022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: CA 95002787) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: CA 723534) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2015-08-14 |