| NPI | 1174098032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: NM RN-76641) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: NM RN-76641) |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2018-10-08 |