| NPI | 1629736673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95305063) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN287661) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2022-12-02 |