| NPI | 1487218236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: CA 95192159) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 95192159) |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2025-05-24 |