| 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 |