| NPI | 1952013179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1655126) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95060742) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2022-12-19 |