| NPI | 1972252054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 95240755) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: CA 95240755) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2022-04-27 |