| NPI | 1891455549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WA2000X Registered Nurse, Administrator (Licence: CA 95194407) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: TX 505049) |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2021-12-22 |