| NPI | 1063964773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95311733) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 286861) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2024-07-26 |