| NPI | 1124901061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM R66470) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NM R66470) |
| 163WH0200X Registered Nurse, Home Health (Licence: NM R66470) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NM R66470) | |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2025-07-29 |