| NPI | 1417716168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95080417) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 870913) |
| Enumeration Date | 2024-03-15 |
| Last Update Date | 2024-03-15 |