| NPI | 1346668134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9286242) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 844681) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2014-03-31 |