| NPI | 1447717657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95191423) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2273544) |
| Enumeration Date | 2019-02-24 |
| Last Update Date | 2019-07-25 |