| NPI | 1720603301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 744995) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CA P38530) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 80602094) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2020-06-10 |