| NPI | 1831672831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 0168533) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN0168533) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2018-09-14 |