| NPI | 1174641526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: CA 16519) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 68585) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2010-09-17 |