| NPI | 1073485934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: CA 95179449) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 95179449) |
| Enumeration Date | 2025-09-20 |
| Last Update Date | 2025-09-20 |