| NPI | 1972741221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 283890) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 194313) |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2009-01-24 |