| NPI | 1306633094 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: AL 1-181634)  | 
| Additional Taxonomies | 163WC1600X Registered Nurse, Continuing Education/Staff Development (Licence: AL 1-181634)  | 
| 163W00000X Registered Nurse (Licence: AL 1-181634)  | |
| Enumeration Date | 2025-04-24 | 
| Last Update Date | 2025-04-24 |