| NPI | 1548479280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN RN144538) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 409820) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-07-11 |