| NPI | 1609205764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC1500X Registered Nurse, Community Health (Licence: CA 80245) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 794401) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2013-11-08 |