| NPI | 1013311919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1063315) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: DC 1006690) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2023-11-01 |