NPI | 1730755372 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95260233) |
Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 688400) |
Enumeration Date | 2021-06-03 |
Last Update Date | 2021-10-18 |