| NPI | 1003007113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1055512) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MD LP40279) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2021-02-20 |