| NPI | 1528689635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 243988) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: SC 243988) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2020-04-29 |