| NPI | 1164095329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 649828) |
| Additional Taxonomies | 163WA2000X Registered Nurse Administrator (Licence: CA RN648928) |
| 163WH1000X Registered Nurse Hospice (Licence: CA RN648928) | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-07-23 |