| NPI | 1972225589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95225236) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: CA 563254) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2022-09-12 |