| NPI | 1912511353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95340241) |
| Additional Taxonomies | 101Y00000X Counselor |
| 164X00000X Licensed Vocational Nurse (Licence: CA 712082) | |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2023-12-25 |