| NPI | 1225605793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95186623) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR 95186623) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2021-06-04 |