| NPI | 1639601198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1687352) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist (Licence: IL 758773) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2024-06-17 |