| NPI | 1669804514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95173603) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 95173603) |
| 163WH1000X Registered Nurse, Hospice (Licence: CA 95173603) | |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2022-04-02 |