| NPI | 1700717741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95435404) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA RN95435404) |
| Enumeration Date | 2026-05-27 |
| Last Update Date | 2026-05-28 |