| NPI | 1376410092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NV 859461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95387074) |
| Enumeration Date | 2025-10-17 |
| Last Update Date | 2025-10-17 |