| NPI | 1548029531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1022173) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: TX 1022173) |
| Enumeration Date | 2024-03-13 |
| Last Update Date | 2024-08-30 |