| NPI | 1770794869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0200X Registered Nurse, Pediatrics (Licence: MO 121132) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MO 121132) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2021-09-30 |