| NPI | 1013750249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN 2521527) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 955920) |
| 163W00000X Registered Nurse (Licence: NY 873246) | |
| Enumeration Date | 2024-06-15 |
| Last Update Date | 2024-07-30 |