| NPI | 1467844647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95208703) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA Vn263721) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2020-10-10 |