| NPI | 1134890874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 95223832) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 95223832) |
| 163WX1100X Registered Nurse, Ophthalmic (Licence: CA 95223832) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-09-22 |