| NPI | 1285055921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO RN.0175277) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC RN.210725 R) |
| Enumeration Date | 2013-12-24 |
| Last Update Date | 2013-12-24 |