| NPI | 1154372977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: WI 110525-030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 110525-030) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-09-11 |