| NPI | 1770358913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN95341518) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9514792) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2023-11-17 |