| NPI | 1982242244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WD1100X Registered Nurse, Dialysis, Peritoneal (Licence: CA 95070652) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: CA 95070652) |
| 163WR0400X Registered Nurse, Rehabilitation (Licence: CA 95070652) | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2019-12-18 |