| NPI | 1265093959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95189315) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 557686) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-06-24 |