| NPI | 1457417982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PR 26922) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: PR 1271) |
| 163WC1500X Registered Nurse, Community Health (Licence: PR 1271) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2025-09-11 |