| NPI | 1205668563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: CA 95375209) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: MD R203682) |
| 163WG0000X Registered Nurse, General Practice (Licence: CA 95375209) | |
| 163WH0200X Registered Nurse, Home Health (Licence: MD R203682) | |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2024-09-06 |