| NPI | 1104789809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WX0601X Registered Nurse, Otorhinolaryngology & Head-Neck (Licence: CA 95292177) |
| Additional Taxonomies | 163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: CA 95292177) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 95292177) | |
| 163W00000X Registered Nurse (Licence: CA 95292177) | |
| Enumeration Date | 2025-12-09 |
| Last Update Date | 2025-12-09 |