| NPI | 1255204517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95086159) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 561631) |
| Enumeration Date | 2025-09-24 |
| Last Update Date | 2025-09-24 |