| NPI | 1346615309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: CA 548450) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95039171) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2015-12-02 |