| NPI | 1104717578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WW0000X Registered Nurse, Wound Care (Licence: TX 1009375) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1009375) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-16 |