| NPI | 1336854769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 201504977RN) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 745442) |
| 163W00000X Registered Nurse (Licence: AZ RN180514) | |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2023-01-19 |