| NPI | 1801176565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95263229) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 255359) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2026-06-28 |