| NPI | 1063865913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1039275) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R195288) |
| 163W00000X Registered Nurse (Licence: DC R195288) | |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2016-07-15 |