| NPI | 1194456442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95199968) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E103783) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-06-17 |