| NPI | 1114638046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 95155205) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95155205) |
| 163WA2000X Registered Nurse, Administrator (Licence: CA 95155205) | |
| 163WH0500X Registered Nurse, Hemodialysis (Licence: CA 95155205) | |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2022-12-12 |