| NPI | 1518791607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN500014195) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: DC RN500014195) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-08-29 |