| NPI | 1083435663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95395120) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 571599) |
| 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA CPT-02040628) | |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-10-19 |