| NPI | 1205302502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PR 87602) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: PR 7723) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2018-10-15 |