| NPI | 1083423800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95371744) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 878643) |
| Enumeration Date | 2025-01-06 |
| Last Update Date | 2025-07-16 |