| NPI | 1922974922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95168025) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 308504) |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2025-10-15 |