| NPI | 1215368741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 752867) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8286070-3102) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2013-12-10 |