| NPI | 1073150686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM RN-75738) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NM 393727) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2019-12-02 |