| NPI | 1386478543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95396896) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 690072) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-11-27 |