| NPI | 1124858014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95316254) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 984022) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-05 |