| NPI | 1992860761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0400X Registered Nurse, Case Management (Licence: MA 123314) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 001150521) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-07-08 |