| NPI | 1770170151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95395819) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 714219) |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2024-11-09 |