| NPI | 1760978589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95085076) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R219028) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2018-07-04 |