| NPI | 1124503776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 252849-30) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WI 321568) |
| Enumeration Date | 2018-09-29 |
| Last Update Date | 2020-05-07 |