| NPI | 1851083539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95262748) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: CA 564780) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-22 |