| NPI | 1093316341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95261464) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 713861) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2022-01-05 |