| NPI | 1952975955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WI0500X Registered Nurse, Infusion Therapy (Licence: CA 95124620) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: CA 95124620) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2021-08-12 |