| NPI | 1629425004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95029154) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 545142) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2016-05-16 |