| NPI | 1477431864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MD R212601) |
| Additional Taxonomies | 163WC0400X Registered Nurse Case Management (Licence: MD R212601) |
| 163WC1500X Registered Nurse Community Health (Licence: MD R212601) | |
| 163WH0200X Registered Nurse Home Health (Licence: MD R212601) | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: MD R212601) | |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-08-25 |