| NPI | 1316298334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 457087) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN098926) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2012-10-01 |