| NPI | 1669716403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 520751) |
| Additional Taxonomies | 163WP2201X Registered Nurse Ambulatory Care (Licence: CA 520751) |
| Enumeration Date | 2012-11-17 |
| Last Update Date | 2012-11-17 |