| NPI | 1912188210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 488581) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 488581) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-20 |