| NPI | 1699177790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 0204933) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 796976) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2014-09-19 |