| NPI | 1336416338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201043114RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 775795) |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2011-11-19 |