| NPI | 1679111355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WI0500X Registered Nurse, Infusion Therapy (Licence: CA 729080) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 729080) |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2019-12-13 |