| NPI | 1285101246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM R26377) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NM 291816) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2019-06-10 |