| NPI | 1306266655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 823814) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CA 823814) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2019-07-02 |