| NPI | 1902395502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 766291) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 766291) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-09 |