| NPI | 1639435456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 786160) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: CA 786160) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2017-10-13 |