| NPI | 1104540210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP2201X Registered Nurse, Ambulatory Care (Licence: MD R5204) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MD R5204) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-12 |