| NPI | 1528696911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: CA 95030276) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: IN 28199519A) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2020-03-31 |