| NPI | 1184500902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CO 1663681) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.590880) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |