| NPI | 1598736803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 657789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN 3208892) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2007-07-08 |