| NPI | 1366705964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 761809) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 720688) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2012-06-19 |