| NPI | 1457940421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95210098) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 291554) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2021-01-14 |