| NPI | 1124553755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 74689) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61314454) |
| 163W00000X Registered Nurse (Licence: CA 95262843) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2023-11-21 |