| NPI | 1487173654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 151689) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: 6086) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-07-21 |