| NPI | 1093456394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95145527) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 087160-21) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2022-04-02 |