| NPI | 1578853222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 122394) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 570720) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |