| NPI | 1700096922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WD0400X Registered Nurse Diabetes Educator (Licence: PR 002) |
| Additional Taxonomies | 163WW0000X Registered Nurse Wound Care (Licence: CA Z7SRKQLJOQ) |
| 163WW0000X Registered Nurse Wound Care (Licence: PR 2894-A) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-09-01 |