| NPI | 1083300727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95335693) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 287721) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-06-15 |