| NPI | 1679016661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WX0800X Registered Nurse, Orthopedic (Licence: CA 708073) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 708073) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2022-10-21 |