| NPI | 1881114601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA RN95307372) |
| Additional Taxonomies | 101Y00000X Counselor |
| 376K00000X Nurse's Aide (Licence: WA 60729253) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2023-01-11 |